Effects of calorie and fluid intake on adverse events during hemodialysis

Strong, Jennifer; Burgett, Marlys; Buss, Mary Lou; Carver, Michelle; Kwankin, Shalini; Walker, Dalene

doi:10.1053/jren.2001.22490

Cited by 9 publications

(20 citation statements)

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“…A similar, but small, prospective observational trial from 2001 of 23 HD patients attempted to quantify the relationship between OI, hypotension, and manitol use during HD. 4 This trial found a statistically significant association between OI and hypotension (defined as SBPo90 mmHg). Patients were 3 times more likely to experience hypotension and 5 times more likely to use mannitol with fluid intake.…”

Section: Discussionmentioning

confidence: 86%

“…1 Food ingestion during HD has been associated with a decline in blood pressure (BP). [2][3][4] Oral intake (OI) is known to cause splanchnic vasodilation. 4 This can lead to hypotension by: (1) increasing splanchnic sequestration of blood and a reduction in cardiac output or (2) through a decrease in splanchnic resistance leading to a reduction in systemic vascular resistance.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Oral intake (OI) is known to cause splanchnic vasodilation. 4 This can lead to hypotension by: (1) increasing splanchnic sequestration of blood and a reduction in cardiac output or (2) through a decrease in splanchnic resistance leading to a reduction in systemic vascular resistance. 3,5 Additionally, HD patients may have an increased incidence of autonomic dysfunction and a blunted response to hemodynamic stressors such as ultrafiltration.…”

Section: Introductionmentioning

confidence: 99%

“…6 Only 2 small prospective preliminary studies have attempted to quantify the relationship between OI and hypotension. 3,4 The primary objective of this study was to estimate the OI in a population of stable HD patients. The secondary objective was to examine the association between OI and hypotentsion in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Oral intake during hemodialysis: Is there an association with intradialytic hypotension?

Benaroia

Iliescu

2008

Hemodialysis International

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Oral intake (OI) of food and fluid has been associated with hypotension during hemodialysis (HD). Trials evaluating this relationship are small. The objective of this study was to quantify OI and to examine its association with hypotension during HD. This is a cross-sectional retrospective chart review study of 3 consecutive HD runs (dialysate iCa=1.25 mmol/L) in 126 stable HD patients (n=378). For each run, the calculation for OI=total ultrafiltration-(net weight loss+IV fluids given). Hypotension was defined as a systolic blood pressure of <100 mmHg at any point during the run. The mean age of the patients was 60.9 years, 38.2% were female, 30.2% had diabetes mellitus, and the majority were Caucasian. The mean (SD) OI was 0.27 (0.352) L/run, range -1.061 to 1.901 L/run, with a normal distribution. In bivariate analysis, there was no correlation of OI with systolic blood pressure, diastolic blood pressure, or mean blood pressure (BP), and the mean OI did not differ among runs with hypotension (n=78) compared with uncomplicated runs (p=0.93). Oral intake was not predictive of hypotension in a multiple logistic regression model controlling for vintage, age, sex, BP medications, coronary disease, dialysis day and shift, diabetes mellitus, s-Ca, Na and ultrafiltration profiles, and dialysis temperature, even when the analysis was restricted to runs where the patients reached the prescribed dry weight within 0.1 kg. The results of this study suggest that the mean OI during dialysis is just over 0.25 kg, with some patients consuming several kilograms. The clinical significance of OI is uncertain. We did not find an association between OI and hypotension. It is likely that this association was confounded by failure to achieve the prescribed dry weight in a proportion of patients with a high OI, as well as interventions implemented in response to hypotension in previous runs. For example, patients with previous episodes of low BP are advised to limit OI, are prescribed profiles, and so on. There may be other deleterious effects of high OI including hypertension and cardiac disease. The generalizability of the results of this largely Caucasian study population is a recognized limitation. Further prospective and blinded studies are needed to examine the association between OI and hypotension, the long-term clinical consequences of OI, and to define thresholds for recommended OI during dialysis.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral intake during hemodialysis: Is there an association with intradialytic hypotension?

Benaroia

Iliescu

2008

Hemodialysis International

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“…We believe that there are several pressing research questions that require addressing in this area, the most important being whether preservation of intestinal blood flow during dialysis is protective or harmful. Studies have previously shown an association between eating during HD and intradialytic hypotension, 29,30 presumably as blood is diverted into the splanchnic circulation. In such a scenario, diversion of blood away from the critical vascular beds would likely be regarded as harmful.…”

Section: The Impact Of Circulatory Stress Upon the Gut In Hdmentioning

confidence: 99%

Hepato‐splanchnic circulatory stress: An important effect of hemodialysis

Grant

Huang

McIntyre

2019

Seminars in Dialysis

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The gastro‐intestinal tract is being increasingly recognized as the site of key pathophysiological processes in the hemodialysis patient. Intestinal dysbiosis, increased intraluminal toxin production, and increased intestinal permeability are commonly observed processes which contribute to the pathogenesis of cardiovascular disease and thus elevated mortality. The acute circulatory effects of dialysis itself may contribute significantly to the development of gastrointestinal dysfunction as a result of both local and distant effects. Additionally, the liver, a relatively unknown entity in this process, has a substantial role as a functional barrier between the portal and systemic circulation and in the metabolism of pathogenic gut‐derived uremic toxins. Here we summarize the evidence for acute gastro‐intestinal and hepatic effects of hemodialysis and identify gaps in knowledge to date which require further study.

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Briefly noted

Sherman¹

2001

Seminars in Dialysis

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Effects of calorie and fluid intake on adverse events during hemodialysis

Cited by 9 publications

References 0 publications

Oral intake during hemodialysis: Is there an association with intradialytic hypotension?

Oral intake during hemodialysis: Is there an association with intradialytic hypotension?

Hepato‐splanchnic circulatory stress: An important effect of hemodialysis

Briefly noted

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